A Cure for Rabies

08Jul

Nearly four thousand years ago, an Akkadian scribe sat and wrote a book of laws. He lived in Eshnunna, north of Ur and wrote in a cuneiform (wedge-shaped) alphabet, impressing his words onto wet clay tablets. Eventually, many years after he died, his civilization would die as well and vanish into dust. Later, much later, Baghdad would rise not far from here and, in 1945 and ’47, the tablets would be found again. But for then he sat and wrote laws. Including this one.

If a dog becomes rabid and the ward authority makes that known to its owner, but [the owner] does not watch over his dog so that it bites a man and causes his death, the owner of the dog shall pay forty shekels of silver; if it bites a slave and causes his death, he shall pay fifteen shekels of silver.

Rabies is one of the oldest recorded diseases and one of the most terrible. It is incurable and attacks both the body and mind. Paralysis and tremors weaken the limbs. Paranoia, hydrophobia, and delirium attack the mind. In Sanskrit it was known as rabhas, which means “to do violence”, this became rabies as the Roman Empire rose, meaning “madness”.

A dog afflicted with the "madness"

It was the 1st century Roman writer Cardanus was the first to identify that the infection was spread through infected saliva. But even identifying the base cause did little to prevent it. In Lyon, France, eight hundred years later a bear wandered into the town square. It would have been incautious and fearsome, with reddened eyes and a foaming mouth. The bear attacked twenty people, six of whom started to show symptoms a few weeks later. They had to be forcibly asphyxiated by their neighbors.

A treatment would be a long time coming. In Europe a device known as St. Hubert’s Key was often the only hope. The key was a long iron bar or nail that was carried by a priest or kept in the house as a charm. If a person was bit, they would have to be restrained as someone else heated the iron over a fire. Once the key started to glow it would be inserted into the wound, hopefully cauterizing the flesh and destroying the disease.

St. Hubert's Key, Belgium, 1880-1920

The key, or other forms of instant cauterization (or even amputation), was imprecise and had to be used immediately. Even then, these devices were often more useful as a magic charm, rather than a cure.

The first modern treatment was developed by the famous Louis Pasteur and Emile Roux in 1895. Pasteur had reasoned that, since rabies affected the mind, the virus must attack the central nervous system. Pasteur had studied Edward Jenner’s use of vaccines and believed that he could create one for rabies out of the nervous tissue of a diseased animal. However, due to the terrible nature of the disease, he was reluctant to attempt human trials. His hand was forced by Joseph Meister’s mother. Joseph, nine years old, had been attacked and mauled by a rabid dog in his hometown of Alsace, France.

Over the next ten days Pasteur treated the child multiple times, injecting him with the weakened viral vaccine. Hopefully the child’s immune system would be moved into action long before the virus spread throughout the nervous system and into the brain (which, by then, would be too late). Joseph Meister survived and the procedure spread, becoming the de facto treatment for rabies. However, like St. Hubert’s Key, the vaccine was dependent on expediency and quick reactions. Once symptoms appeared, the patient would invariably die, no matter what.

It wouldn’t be until the twenty-first century when a successful post-symptomatic cure was developed. In 2004, Dr. Rodney Willoughby, Jr was introduced to a fifteen year old girl named Jenna Giese. A few weeks before, Giese had been bitten by a rabid bat behind her church in Fond du Lac, Wisconsin. The girl bandaged and treated the admittedly small bite and paid it no more attention. It wasn’t until she developed tremors, fevers, and neurological problems that the family thought of rabies.

She should have died. However, Willoughby reasoned that, since people usually passed away due to a frenzy of nervous signals interrupting regular breathing and heartbeat, shutting down the nervous system should allow the immune system enough time to kill the virus while still keeping the girl alive. The procedure, now known as the Milwaukee Protocol, saved her life, making her the first recorded person to survive rabies post-symptoms. The protocol has since been used to save five other people. It’s success rate is low, but the procedure is still undergoing refinement, and hopefully should improve with time.